Surgery-assisted transmesenteric transjugular intrahepatic portosystemic shunt for esophagogastric bleeding in patients with cavernous transformation of the portal vein.

This editorial provides commentary on the study by Wu et al, which investigates a novel intervention for a challenging clinical scenario: Transjugular intrahepatic portosystemic shunt (TIPS) placement with the assistance of surgery in patients with cavernous transformation of the portal vein. The authors compared surgically assisted TIPS (SATIPS) in 54 patients to endoscopic sclerotherapy in 53 patients. While 3-month survival rates were similar (94.4% vs 92.5%), a significant difference emerged at 6 months, with survival rates of 94.4% for SATIPS vs 73.6% for endoscope sclerotherapy. The SATIPS group also demonstrated significantly lower incidences of liver failure, esophagogastric bleeding, and hepatic encephalopathy at 6 months. However, the SATIPS procedure was not without risk, as four patients experienced major complications, including intraoperative hemorrhage. The study concludes that SATIPS is an effective alternative for cavernous transformation of the portal vein patients with esophagogastric bleeding, but its findings must be interpreted in light of its limitations. This research represents a significant contribution to the field.